US8709738B2 - Methods for predicting cardiac toxicity - Google Patents

Methods for predicting cardiac toxicity Download PDF

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US8709738B2
US8709738B2 US12/280,893 US28089307A US8709738B2 US 8709738 B2 US8709738 B2 US 8709738B2 US 28089307 A US28089307 A US 28089307A US 8709738 B2 US8709738 B2 US 8709738B2
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Sarah S. Bacus
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    • G01N33/5044—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving specific cell types
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    • G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis

Definitions

  • the heart has a tremendous capacity for ATP generation which allows it to function as an efficient pump throughout the life of the organism.
  • the adult myocardium uses either fatty acid (FA) and/or glucose oxidation as its main energy sources. Under normal conditions, the adult heart derives most of its energy through oxidation of fatty acids in mitochondria.
  • FA fatty acid
  • glucose oxidation oxidation of fatty acids in mitochondria.
  • Cells of the myocardium have the ability to switch between carbohydrate glycolysis and the Krebs cycle and to fat fuel sources so that ATP production is maintained at a constant rate under diverse physiological and dietary conditions. This metabolic and fuel selection flexibility is important for normal cardiac function. Although cardiac energy conversion capacity and metabolic flux is modulated at many levels, one important mechanism of regulation occurs at the level of gene expression. The expression of genes involved in multiple energy transduction pathways is dynamically regulated in response to developmental, physiological, and pathophysiological cues.
  • the genes involved in these key energy metabolic pathways are transcriptionally regulated by members of the nuclear receptor superfamily, specifically the fatty acid-activated peroxisome proliferator-activated receptors (PPARs) and the nuclear receptor coactivator, PPAR ⁇ coactivator-1 ⁇ (PGC-1 ⁇ ), as well as the estrogen receptor-related protein ERR ⁇ , ERR ⁇ and ERR ⁇ and their activators PGR-1 and PERC.
  • PPARs fatty acid-activated peroxisome proliferator-activated receptors
  • PSC-1 ⁇ nuclear receptor coactivator-1 ⁇
  • PGC-1 ⁇ is a PPAR ⁇ coactivator, linked to adaptive thermogenesis in brown adipose.
  • Two structurally related proteins, PGC-1 ⁇ and PARC, have been cloned and appear to be involved in regulating energy metabolic pathways.
  • the tissue-specific and inducible nature of PGC-1 ⁇ expression suggests its involvement in the dynamic regulation of cellular energy yielding metabolic processes, including mitochondrial biogenesis and oxidation, hepatic gluconeogenesis, and skeletal muscle glucose uptake.
  • PGC-1 ⁇ is selectively expressed in highly oxidative tissues such as heart, skeletal muscle, brown adipose, and liver. In the heart PGC-1 ⁇ expression increases sharply at birth. This coincides with a perinatal shift from glucose metabolism to fat oxidation.
  • PGC-1 ⁇ activity and expression levels are also known to be induced by cold exposure, fasting, and exercise; stimuli known to promote oxidative metabolism. Forced expression of PGC-1 in cardiac myocytes in culture induces expression of nuclear and mitochondrial genes involved in multiple mitochondrial energy-transduction/energy-production pathways, increases cellular mitochondrial number, and stimulates coupled respiration. Signaling pathways associated with these stimuli, including p38 MAP kinase, ⁇ -adrenergic/cAMP, nitric oxide, AMP kinase, and Ca 2 -calmodulin kinase, activate PGC-1 ⁇ and its downstream target genes either by increasing PGC-1 ⁇ expression or its transactivation function.
  • ERR estrogen-related receptor
  • ERR ⁇ estrogen-related receptor
  • ERR ⁇ ERR ⁇
  • ERR ⁇ ERR ⁇
  • ERR ⁇ expression is elevated in adult tissues that rely primarily on mitochondrial oxidative metabolism for ATP production, such as heart and slow twitch skeletal muscle.
  • ERR ⁇ expression dramatically increases in heart after birth, in parallel with the global upregulation of enzymes involved in cellular fatty acid uptake and mitochondrial oxidation.
  • ERR ⁇ and ERR ⁇ were identified as novel partners for the PGC-1 family of coactivators. This functional relationship between ERR isoforms and PGC-1 ⁇ have stimulated interest in the role of ERRs in energy metabolism.
  • ERR ⁇ Deletion of the ERR ⁇ gene reveals a tissue-specific role for ERR ⁇ in constitutive regulation of lipid metabolism.
  • White adipose mass is decreased in ERR ⁇ - / - mice coincident with decreased adipocyte size and lipid synthesis rates.
  • ERR ⁇ likely plays a role in lipid catabolism in heart, consistent with its functional interaction with PGC-1 ⁇ .
  • ERR ⁇ - / - mice which do not display an overt cardiac phenotype, exhibit a compensatory increase in cardiac PGC-1 ⁇ and ERR ⁇ expression.
  • ERR ⁇ activates genes involved in energy production pathways, including cellular fatty acid uptake (LPL, CD36/FAT, H-FABP, FACS-1), ⁇ -oxidation (MCAD, VLCAD, LCHAD), and mitochondrial electron transport/oxidative phosphorylation (cytochrome c, COXIV, COXVIII, NADH ubiquinone dehydrogenase, flavoprotein-ubiquinone oxidoreductase, ATP synthase ⁇ ). ERR ⁇ also increases palmitate oxidation rates in cardiac myocytes.
  • ERR ⁇ Activation of ⁇ -oxidation enzymes genes by ERR ⁇ involves the PPAR ⁇ signaling pathway.
  • ERR ⁇ directly activates PPAR ⁇ gene expression, and ERR ⁇ -mediated regulation of MCAD and M-CPT I is abolished in cells derived from PPAR ⁇ - / - mice.
  • ERR ⁇ is also now known to be involved in the PGC-1 ⁇ regulation of mitochondrial biogenesis. It is known to mediate PGC-1 ⁇ activation of the NRF pathway through regulation of the Gapba gene, which encodes a subunit of the NRF-2 complex and directly activates genes involved in mitochondrial oxidative metabolism at the level of transcription.
  • ERR ⁇ with its coactivator PGC-1 ⁇ activates the MCAD, cytochrome c, and ATP synthase ⁇ gene promoters.
  • the nuclear receptor ERR ⁇ (estrogen related receptor gamma) is highly expressed in heart, skeletal muscle, kidney, and brain, as well as in the developing nervous system.
  • the expression of the coactivators PGC-1 ⁇ and PGC-1 ⁇ in mammalian cells potently augmented transcriptional activation by ERR ⁇ .
  • the constitutive activation function 2 (AF-2) of the orphan receptor is important for the synergistic enhancement.
  • Functional receptor truncation analysis has been used to identify an additional amino-terminal activation function, specific for the ERR ⁇ 2 isoform and PGC-1 ⁇ . In vitro experiments showed a direct interaction of ERR ⁇ with both coactivators.
  • PGC-1 Cardiac-specific overexpression of PGC-1 in transgenic mice results in uncontrolled mitochondrial proliferation in cardiac myocytes leading to loss of sarcomeric structure and a dilated cardiomyopathy.
  • PGC-1 is an important regulatory molecule in the control of cardiac mitochondrial number and function in response to energy demands.
  • Methods are disclosed for diagnosing whether toxicity, especially cardiotoxicity, is likely to occur in a patient selected for treatment with a variety of drugs, such as tyrosine kinase inhibitors or erbB inhibitors. Methods are also disclosed for evaluating whether a candidate drug is likely to have a toxic or cardiotoxic affect.
  • lipids such as triglycerides and cholesterol
  • enzymes responsible for the observed fatty acid oxidation such as MCAD, can be determined.
  • AMP-activated protein kinase activation can lead to a characteristic reduction in the level of lipids and a corresponding increase in glycolytic and shorter carbon chain intermediates, for example of C 2 to C 6 carbon intermediates.
  • Any statistically significant deviation from the characteristic lipid reduction in normal cells can be considered, for purposes of this disclosure, a fatty acid oxidation disorder.
  • any statistically significant change, relative to normal cells, in the amount of activity or levels of these enzymes as measured by Western, Northern, PCR or other techniques can be considered, for purposes of this disclosure, a fatty acid oxidation disorder.
  • the diagnosis of a fatty acid oxidation disorder can be used to predict an increased risk of toxicity and possibly as a contra-indicator for the use of the drug.
  • the methods can be used to indicate the need to closely follow cardiac function in the patient.
  • glucose uptake can be measured by known methods, such as by positron emission tomography. In situations where glucose uptake is not diminished or is not diminished to the same extent as in normal noncancerous cells upon administration of a tyrosine kinase inhibitor drug, then the drug treatment is likely to be toxic to the noncancerous cells. Alternatively, if ATP levels decrease more than in normal noncancerous cells upon exposure to a tyrosine kinase inhibitor, then the tyrosine kinase inhibitor is predicted to be toxic.
  • Another method for predicting whether cardiotoxicity in a patient selected for treatment with a drug is to assess the TNF ⁇ levels in the patient, either in the tumor or blood or both.
  • the level of TNF ⁇ can be used to predict whether a patient is likely to have an adverse event related to cardiotoxicity resulting from drug, particularly HERCEPTIN®, therapy.
  • AMP activated protein kinase AMP activated protein kinase
  • the method is based on the surprising discovery that activators of AMP activated protein kinase cause a shift in cell metabolism such that lipids are oxidized into smaller carbon intermediates. The metabolic shift results in a surprising reduction in the lipid content of treated cells.
  • Administration of AMP activated protein kinase activators in amounts that are sufficient to activate AMP activated protein kinase can be used to cause cells to loose a portion of their lipid content.
  • Many methods for administering such compounds to cells are known and can be used.
  • Local or systemic administration can be used. Local administration can be by injection, by a skin patch or a salve or lotion.
  • a method for administering an AMP activated protein kinase activator to a patient, or including it in a medium for incubation with an organ, in an amount that is sufficient to protect organs such as heart muscle and/or brain cells from the acute distress that would normally result from such trauma as ischemia, cytokine release, glucose deprivation and similar events that cause metabolic tension in such cells and organs where such conditions are diagnosed.
  • Dual kinase inhibitors particularly tyrosine kinase inhibitors that cause an increase in AMP activated protein kinase activity, can also be used.
  • kinase inhibitors will be specific for their targets as described further in the detailed description.
  • Many methods of administration are known and can be used.
  • the drugs can be included in solutions for perfusing organs or can be administered systemically.
  • a method for preserving an organ for transplant involves preparing a preservation solution comprising an AMPK activator and contacting the organ with the preservation solution.
  • the preservation solution can be any known preservation solution to which an AMPK activator is added in a sufficient amount to provide improved protection for the organ.
  • FIG. 1 is a listing of genes regulated by HERCEPTIN® treatment in Au565 cells.
  • FIG. 2 are photographs of Au-565 cells treated by NDF or HERCEPTIN® and stained for lipids.
  • FIG. 3 are photographs of Au-565 cells treated by GW-2974 and stained for lipids.
  • FIG. 4 are photographs of primary human cardiac myocytes grown under various conditions and stained for lipids.
  • FIG. 5 is a bar graph illustrating the percentage of human cardiomyocytes testing positive for lipids under various conditions.
  • FIG. 6 are photographs of MDA-MB-468 cells treated by GW-2974 and intracellular Ca detected by Fluoro-4.
  • FIG. 7A a photograph of a Western Blot showing the affect of certain tyrosine kinase inhibitors on expression p-eEF2 and p-AMPK ⁇ .
  • FIG. 7B is a photograph of stained cells showing the expression of p-eEF2 in Au565 cells in the presence of various compounds.
  • FIG. 8 is a photograph of ERR ⁇ and MCAD in cardiomyocytes cells with and without treatment by various kinase inhibitors.
  • FIG. 9 is a bar graph illustrating the growth inhibition of HMCs treated with combinations of different types of erbB inhibitors and TNF ⁇ .
  • FIG. 10 is a western blot of HMCs probed for NF- ⁇ B after treatment with either TNF ⁇ ; GW2974 or HERCEPTIN® (or combinations).
  • the present disclosure is based on the discovery that drugs, such as tyrosine kinase inhibitors, like HERCEPTIN® and lapatinib (TYKERB®), affect the expression of genes associated with lipid metabolic pathways and dramatically affect the amount of lipid within the cells.
  • drugs such as tyrosine kinase inhibitors, like HERCEPTIN® and lapatinib (TYKERB®)
  • tyrosine kinase inhibitors like HERCEPTIN® and lapatinib (TYKERB®
  • kinase inhibitors such as GW2974, GW572016, the lipid stored within those cells rapidly disappears. This observation has also been made in cardiac cells.
  • kinase inhibitors are also known to be useful as chemotherapeutic agents. In some patients these drugs produce cardiotoxicity.
  • the present disclosure is based on the surprising discovery that cardiotoxicity can be associated with defects in fatty acid metabolism.
  • patients with certain dysfunctions in fatty acid metabolism or that have high levels of TNF ⁇ in blood, and that are undergoing treatment with kinase inhibitors are more likely to suffer from cardiac malfunction such as cardiomyopathy upon treatment with kinase inhibitors such as erbB tyrosine kinase inhibitors.
  • kinase inhibitors such as erbB tyrosine kinase inhibitors.
  • erbB tyrosine kinase inhibitors it has been discovered that patients having high levels of TNF ⁇ , or its downstream survival factor NF- ⁇ B, in tumor tissue or serum generally have a better response to HERCEPTIN®. This discovery has led to the development of new methods for predicting whether patients will suffer from cardiotoxicity upon treatment with drugs, including kina
  • the results from such analysis can then be used to predict when cardiotoxicity could result from kinase inhibitor treatment and to provide an early indication that cardiac function should be closely monitored in patients undergoing treatment with drugs, such as kinase inhibitors, including HERCEPTIN®, GW572016 or other erbB inhibitors.
  • 5-′AMP-activated protein kinase which has been shown to phosphorylate and inactivate acetyl-CoA carboxylase in other tissues, has been discovered to be significantly increased at the end of ischemia, and remains elevated throughout reperfusion. Accumulation of 5′-AMP during ischemia results in an activation of AMP-activated protein kinase, which phosphorylates and inactivates acetyl-CoA carboxylase during reperfusion. The subsequent decrease in malonyl-CoA levels can result in accelerated fatty acid oxidation rates during reperfusion of ischemic hearts.
  • fatty acids can be fed to an individual and their metabolism followed.
  • enzyme levels can be determined as in Western blots or mRNA levels for certain gene products can be analyzed, for example. Any detectable decrease provides an indication that a fatty acid oxidation disorder exists and that treatment with a tyrosine kinase inhibitor may be toxic to normal cells and organs.
  • patients who are candidates for treatment with kinase inhibitors can be screened for these diseases to determine whether they are likely to suffer myocardiocyte toxicity.
  • the biological macromolecules can be determined in myocardiocytes grown in culture to determine how the levels of these macromolecules are affected by administration of the candidate drug.
  • human myocardiocytes can be grown in culture and the level of phosphorylated AMP-activated protein kinase can be monitored in the presence of the candidate drug. This can be determined by a Western blot that detects the phosphorylated AMP activated kinase.
  • AMP-activated protein kinase AMP-activated protein kinase
  • ACC acetyl-CoA carboxylase
  • HMG-CoA reductase HMG-CoA reductase
  • AMPK upstream AMPK kinases
  • CAMKK ⁇ calmodulin-dependent kinase kinase ⁇
  • LKB1 a serine/threonine kinase encoded by the Peutz-Jegher syndrome tumor suppressor gene.
  • AMPK acetyl-CoA carboxylase
  • ACC acetyl-CoA carboxylase
  • CPT 1 carnitine palmitoyltransferase 1
  • De-repression of CPT 1 is thought to cause the concomitant increase in ⁇ -oxidation of fatty acid, which is thought to lead to increased mitochondrial production of ATP.
  • Stress-induced activation of AMPK is also thought to inhibit protein synthesis by inhibiting mTOR and directly modulating eEF2, a translation elongation factor known to be associated with cardiac protection.
  • GW2974 a potent small molecule HER2/EGFR tyrosine kinase inhibitor with a similar activity profile to lapatinib, that can activate AMPK and its downstream substrates stimulate fatty acid oxidation, which in turn increases ATP production in HER2-expressing human cardiomyocytes, protecting against apoptosis induced by TNF ⁇ , a known cytokine detected in cardiac failure.
  • trastuzumab that do not activate AMPK result in enhanced cardiomyocyte cell death in response to TNF ⁇ .
  • HER2-targeted therapies on AMPK and consequently energy production may predict for the risk associated cardiomyopathy and provide a novel HER2-directed therapeutic strategy to protect myocardium from the killing effects of TNF ⁇ or other pro-apoptotic stimuli, following acute ischemic injury.
  • tyrosine kinase inhibitors can be used to reduce fat in cells, particularly cells that are otherwise normal or that lack protein tyrosine kinase activity mediated disease.
  • a mammal or tissue can be treated with a kinase inhibitor such that the amount of lipid in the cells is reduced.
  • Any suitable kinase inhibitor can be used. Methods for determining suitable inhibitors are well known. For example, samples of adipocytes can be grown in the presence and absence of a kinase inhibitor and stained with Oil red 0 by known methods to determine whether the kinase inhibitor causes a reduction in stored fat.
  • kinase inhibitors that cause an observable reduction in fat storage are suitable for the present invention.
  • Exemplary kinase inhibitors that are suitable for the invention include erbB inhibitors, especially including GW2974, GW572016, and the like. Table II below shows the reduction in lipid content obtained by treatment with GW2974.
  • Au565 cells were grown under normal conditions known in the art and treated for 2 days with GW2974 (25 ⁇ M). The cells were collected, washed and sonicated in water (2,000,000 cells in 200 ⁇ L of water). The cells were spun down and were tested for acylcamitines (byproducts of mitochondrial fatty acid oxidation) by MS/MS for intraceullar metabolites.
  • cells can be treated with suitable kinase inhibitors to reduce lipid storage.
  • the method can include the steps of contacting the cells with a sufficient amount of a suitable tyrosine kinase inhibitor to cause the cell to rid itself of an amount and preferably most or, more preferably, virtually all of its surplus of stored lipids.
  • the cells can be in an in vitro cell culture or can be located in an individual. The method is particularly effective when used on cells that are disease free or free from protein tyrosine kinase activity related diseases.
  • Methods are also disclosed for administering a kinase inhibitor, such as a tyrosine kinase inhibitor or dual tyrosine kinase inhibitor, to a patient, such as during heart reperfusion or during a heart attack, in order to counteract the fatty acid oxidation effect and protect the heart muscle and/or brain cells.
  • a kinase inhibitor such as a tyrosine kinase inhibitor or dual tyrosine kinase inhibitor
  • Such treatments can be used to protect heart cells, brain cells and cells from other tissues and organs from acute distress caused by ischemia, cytokine release, glucose deprivation or other maladies that metabolically stress such cells.
  • the kinase inhibitors are specific in that they cause a shift in metabolic activity and do not affect unrelated targets.
  • the specificity of various kinase inhibitors can be determined by methods described in Fabian et al., A small molecule - kinase interaction map for clinical kinase inhibitors , Nature Biotechnology 23, p. 329 which is incorporated by reference. It is believed that the shift in metabolic activity is brought about through an increase in AMP activated protein kinase activity.
  • the active agent can be administered to an individual orally, locally by injection or through a skin patch, a salve or a lotion or can be administered parenterally so long as it reaches the intended target cells in a sufficient amount to exert its lipid reducing effect.
  • the AMP activated protein kinase activators can be administered as salts or solvates or as free chemicals, however, it is preferred to administer the inhibitors in the form of a pharmaceutical formulation.
  • the formulation can contain, in addition to the active agent, one or more pharmaceutically acceptable carriers, diluents or excipients.
  • the pharmaceutical formulations can be presented in unit dose forms containing a predetermined amount of active ingredient per unit dose.
  • a unit can contain for example 0.5 mg to 1 g, preferably 70 mg to 700 mg, more preferably 5 mg to 100 mg of active agent depending on the route of administration and the age, weight and condition of the patient.
  • 100 mg/kg of GW2974 can be administered to preserve the heart during a period of starvation.
  • compositions can be adapted for administration by any appropriate route, for example by the oral (including buccal or sublingual), rectal, nasal, topical (including buccal, sublingual or transdermal), vaginal or parenteral (including subcutaneous, intramuscular, intravenous or intradermal) route.
  • Such formulations can be prepared by any method known in the art of pharmacy, for example by bringing into association the active ingredient with the carrier(s) or excipient(s).
  • compositions adapted for oral administration can be in the form of capsules or tablets; powders or granules; solutions or suspensions in aqueous or non-aqueous liquids; edible foams or whips; or oil-in-water liquid emulsions or water-in-oil liquid emulsions and in liposomes.
  • compositions for transdermal administration can be presented as discrete patches intended to remain in intimate contact with the skin of the recipient for a prolonged period of time.
  • the active ingredient can be delivered from the patch by iontophoresis by known methods.
  • compositions for topical administration can be formulated as ointments, creams, suspensions, lotions, powders, solutions, pastes, gels, sprays, aerosols or oils.
  • the formulations can be applied as a topical ointments or creams.
  • the active agent can be employed with either a paraffinic or a water-miscible ointment base.
  • the active agent can also be formulated in a cream with an oil-in-water cream base or a water-in-oil base.
  • such ointments will allow the active agent to penetrate the skin and contact target cells and tissues, particularly for the amelioration of fat in fat laden tissue and organs.
  • compositions adapted for topical administration in the mouth include lozenges, pastilles and mouth washes.
  • Fine particle dusts or mists which can be generated by means of various types of metered dose pressurised aerosols, nebulizers or insufflators.
  • compositions for vaginal administration can be presented as pessaries, tampons, creams, gels, pastes, foams or spray formulations.
  • compositions for parenteral administration can include aqueous and non-aqueous sterile injection solutions which can further include anti-oxidants such as tocopherol, buffers, bacteriostats and solutes to make the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which can include suspending agents and thickening agents.
  • anti-oxidants such as tocopherol, buffers, bacteriostats and solutes to make the formulation isotonic with the blood of the intended recipient
  • aqueous and non-aqueous sterile suspensions which can include suspending agents and thickening agents.
  • Formulations can be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and can be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.
  • sterile liquid carrier for example water for injections, immediately prior to use.
  • Extemporaneous injection solutions and suspensions can be prepared from sterile powders, granules and tablets.
  • Preferred unit dosage formulations are those containing a daily dose or sub-dose, or an appropriate fraction of an active ingredient.
  • formulations can include other agents conventional in the art having regard to the type of formulation in question, for example those suitable for oral administration can include flavoring agents.
  • the animal requiring treatment with a compound, salt or solvate of the present invention is usually a mammal, such as a human being.
  • Therapeutically effective amounts of the active agent, salt or solvate of the present invention will depend upon a number of factors including, for example, the age and weight of the animal, the severity of the condition requiring treatment, the nature of the formulation, and the route of administration, and will ultimately be at the discretion of the attendant physician or veterinarian.
  • an effective amount of a compound of the present invention for the treatment of toxicity will generally be in the range of 0.1 to 500 mg/kg body weight of recipient (mammal) per day and more usually in the range of 1 to 200 mg/kg body weight per day.
  • the actual amount per day would usually be from 70 to 700 mg and this amount can be given in a single dose per day or any number of sub-doses per day such that the total daily dose is the same.
  • An effective amount of a salt or solvate of the present invention can be determined as a proportion of the effective amount of the compound per se.
  • Combination therapies according to the present invention thus comprise the administration of at least one AMP activated protein kinase activator of the invention or a pharmaceutically acceptable salt or solvate thereof and at least one other pharmaceutically active agent, such as a cancer therapeutic.
  • Combination actives can be administered together or separately and, when administered separately can be administered simultaneously or sequentially in any order.
  • the amounts of the kinase inhibitor of the invention and the other pharmaceutically active agent(s) and the relative timings of administration will be selected in order to achieve the desired combined therapeutic effect.
  • the following example demonstrates the identification of genes that are affected by treatment of HERCEPTIN® in an in vitro cell culture of Au565 cells.
  • Au565 cells were grown under normal conditions and treated with HERCEPTIN® or left untreated. Cells were pelleted, snap frozen in liquid nitrogen and analyzed in a microarray using standard conditions. Cy3 and Cy5 labeled cDNA was prepared from RNA isolated from the cell pellets. Genes involved in lipid metabolism are shown in Table III. Genes involved in other pathways that were either upregulated or downregulated are also shown in FIG. 1 .
  • ELOVL2 Homo sapiens elongation of very long chain fatty ⁇ 4.36E ⁇ 01 acids (FEN1/Elo2, SUR4/Elo3, yeast)-like 2 (ELOVL2), mRNA HPCAL1 Hippocalcin-like 1, a putative calcium-sensing protein, ⁇ 4.53E ⁇ 01 member of the neural visinin-like (NVP) family of calcium-binding proteins, localized to axons and dendrites, can play a role in neuronal signaling in the central nervous system KCNG2 Potassium voltage channel subfamily gamma 2, a ⁇ 5.53E ⁇ 01 member of the Kv6 family of ion channels, functions as a votage-gated potassium channel upon interaction with Kv2.1 alpha subunit, can contribute
  • FIG. 2 shows that Au565 cells treated with either an ErbB stimulatory ligand, NDF, or the monoclonal antibody HERCEPTIN®, both result in the production of lipids. This is shown by the staining of lipids with oil red (lipids are represented by red dots) against the background counterstaining of the cells (hematoxylin).
  • FIG. 3 shows that lipids are present in untreated Au565 cells but are reduced in cells treated with the dual EGFR and ErbB2 inhibitor, GW2974.
  • FIG. 4 shows cardiomyocyte cells treated with either GW2974, Herceptin or NDF. Lipids increase in cells treated with Herceptin and NDF (compared with untreated cells) but not decrease in cells treated with GW2974.
  • FIG. 5 shows a quantitative measure of lipids in control, HERCEPTIN® and GW2974 treated cells.
  • FIG. 6 Treatment of cells with GW2974 causes a redistribution of intracellular calcium ( FIG. 6 ). This can be seen in MDA-MB-468 breast cancer cells where calcium is detected by fluorescently by Fluoro-4. This redistribution of calcium results in the activation and phosphorylation of AMPK.
  • Activated AMPK represses translation by phosphorylation of the translation factor eEF-2 ( FIG. 7 ), which inactivates eEF-2 and represses protein synthesis, a known effect of TKIs.
  • FIG. 7A shows a western blot of Au565 cells treated with either a stimulatory ligand (EGF) or GW2974 and probed for p-eEF-2.
  • EGF stimulatory ligand
  • FIG. 7B shows expression of p-eEF-2 by IHC.
  • C225 and HERCEPTIN® do not increase p-eEF-2, however TKIs like Iressa, GW2974 and rapamycin do.
  • ERR ⁇ plays a role in lipid metabolism in cardiac cells
  • MCAD is an enzyme that breaks down lipids and fatty acids. Mutations in MCAD is a common genetic disorder, especially in those of northern European descent.
  • FIG. 8 shows that in HERCEPTIN® treated cells, the level of ERR ⁇ diminished slightly. MCAD is expressed in HERCEPTIN® treated cells but is completely absent from GW2974 treated cells.
  • the following example demonstrates the change in mRNA expression profile of cells treated with GW2974.
  • Au565 cells were grown under normal conditions and were untreated or treated with GW2974 (25 ⁇ M). Cells were pelleted, snap frozen in liquid nitrogen and subjected to microarray analysis. RNA was isolated using the Agilent Total RNA Isolation Kit. Cy3 and Cy5 labeled cRNA was prepared using the Agilent Low RNA Input Fluorescent Linear Amplification Kit. Labeled cRNAs were hybridized to a G4110A Human 1A(V2) microarray consisting of 60-mer oligonucleotides representing over 18K well-characterized, full length, human genes. Table IV provides the results in Table form.
  • TABLE IV GW2974 change compared Gene Name Description to control TABLE IV A - Ion Channel FLJ12476 Protein containing an IQ calmodulin-binding domain 5.0x CAMK4 Calcium/calmodulin-dependent protein kinase IV, a 4.5x protein kinase involved in Ca(2+)-regulated gene expression, including CREBBP-dependent gene expression AVIL Protein with high similarity to villin 1 (human VIL1), 4.2x which is a calcium-regulated actin-binding protein that caps, severs, and bundles actin filaments, member of the gelsolin family and contains a villin headpiece domain SCN1A Sodium channel voltage-gated type I (alpha subunit), 4.1x a voltage-sensitive sodium channel; mutations are associated with severe myoclonic epilepsy of infancy and generalized epilepsy with febrile seizures plus CLSP Calmodulin-like skin protein, a member of the ⁇ 4.0x calmodulin family of calcium-binding proteins, may play

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